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Home My WebLink AboutSPRING FOREST BLK 2 LT 6Spring Forest Block 2 Lot 6 #015-321-24 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221296 PID Number: 015-321-24 Dwelling: 9 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New I■❑ Upgrade Name Austin Fuhrig & Laura Eichelberger ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 6011 West Tree Drive, Anchorage, AK 99507 ❑ Other Phone7Number of Bedrooms Rating depth from original grade 4 GPD/SF JTotal Ft. LEGAL DESCRIPTION Depth to pipe in from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Spring Forest 2 6 Fill added above original grade Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lin-ts,, Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. betw77�t. From Tank Field Tank Line Ftz Well >100' >1 00' N/A N/A >25 TANK 0 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity 1250 Gal. Surface Water >1 >1 00' N/A N/A Material Plastic Number of compartments 2 Lot Line >5' >10' N/A N/A NA Foundation >1 >10' N/A N/A TATION Manufacturer Capacity Remarks Confirmed 5' separation from tank to all Gal. deck supports during intallation Alarm location Elects tailed by to PIPE MATERIAL House to tank D3034 dD3034 Installer A. C. E. S rainfieldTank Drainfield N/A CO/MT D3034 Inspector L.Tidwell BENCH MARK (Assumed elevation) 100 ft Inspection 1St 7/28/22 7/28/22 Location and description dates: 2nd ani 4m ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp ~'S• Conditional Approval: Date • •gSll� ' cb /*:•* 49TH Septic Ssy�tem r Approve Date Benjamjvrt�Schiller ¢ F`•• CE 12592 ••`�� c�srF9• a/1s/22 . •�� l�l�O PROFESSIONP� Note: this approval does not include well permit requirements. �,�®��- tKev u5iuuiu/ SPRING FOREST, BLOCK 2 LOT 6 PERMIT # OSP221296 PID # 015-321-24 i 510 f t � 530'LOST 7 _ �.. r LOT 2 540— ENGINEERING 01 W.•,i,1, *: 49 TH Benja i Schiller ' 2592 i ol�JlF�FOP anen 2 • P��c��.o ��`„ ROfESSION U FCO 16.6 24.2 MH SV1 21.5 24.4 27.2 29.3 2C01 29.3 32.7 2CO2 1 28.2 33.4 EXISTING TRENCHES TO REMAIN IN SERVICE NEW 1250 -GAL SEPTIC TANK W/20" MANWAY RETAINING WALL --/ ° 10' UTILITY EASEMENT\— ti PLAN AS -BUILT 0 50 100 FEET 111=50' LEGEND CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEAN( FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE SPRING FOREST, BLOCK 2 LOT 6 PERMIT # OSP221296 FOR.GE PID # 015-321-24 PROFILE AS -BUILT (NO SCALE) O O N O U') 0 N u x U O CL w w 1. Z W u W Q }W O LO IW Z O W ~w N W ` ^�/ N 0 / jr �w O/ -#1- r- 0 0 1. Z W u W Q }W O LO Q � N m} C E LLI (Y LL1 to Q V) } 8 Z O = U H O a J_ z O :� W ` ^�/ N o / jr IQ O/ -#1- r- 0 0 ^O Q � N m} C E LLI (Y LL1 to Q V) } 8 Z O = U H O a MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 396650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP221296 Work Type: SepticTank Upgrade Tax Code Number: 01532124000 Site Legal Address: SPRING FOREST BLK 2 LT 6 6:2538 Site Mailing Address: 6011 WEST TREE DR, Anchorage Owner: FUHRIG AUSTIN & Design Engineer: FORGE ENGINEERING This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: ��Zzrnr h r� Uelrrrtnter�t 7/28/2022 7/28/2023 53154 ❑ Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (2417). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: 1) If tank goes in before the deck piles, the contractor shall delineate the outline of the tank on the ground surface so that the contractor that drives the piles knows where it is. 2) If the piles end up close to the tank, the engineer shall verify that there was no damage to the tank (i.e. confirm it's water -tight). Veronica Pope GE 2022.07.28 Received By: 16:0 A43 -08'00' f Issued By: ��4Uvuu. Date: r� Date: 4 MUNICIPALITY OF ANCHORAGE Community Development Department_ Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 015-321-24 Property owner(s) Austin Fuhrig & Laura Eichelberger Day phone Mailing address 6011 West Tree Drive, Anchorage, AK 99507 Site address 6011 West Tree Drive Legal description (Sub'd., Block & Lot) Spring Forest, Block 2 Lot 6 Legal description (Township, Range & Section) Lot Size 53,154 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑ (w/wo ADU) Septic Tank 0 Upgrade Q (D) ❑ Holding Tank ❑ RenewalDuplex ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: (D Date of Payment: I a-, a O Q Receipt Number: Permit No. 0 Permit App_::- ::'-.,:c ; Waiver Fees: Date of Payment: Receipt Number: Waiver No. July 26, 2022 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Spring Forest B2 L6 - 6011 W Tree Dr Septic tank replacement permit Dear On-Site Services Engineer: The owner of the above lot intends has a tank that approaching end-of-life, and they would like to replace it before building a deck in the back yard. The attached. The attached site plan identifies the location of the proposed tank as well as the existing tank, home, septic trench, and water line. No conflicts exist between this proposed location and any other water system or septic system, whether on this lot or adjacent lots. The new tank will be located more than 100’ from all wells and surface water, more than 10’ from the home foundation and water lines, and more than 5’ from the absorption field. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Benjamin Schiller, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221296, Rebecca Carroll, 07/28/22 // Benjamin Schiller CE 12592R EGISTEREDPROFES S I O N ALENGINEER 1"=50' NEW 1250-GAL SEPTIC TANK W/20" MANWAY CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND SPRING FOREST, BLOCK 2 LOT 6 FEET 0 50 100 NOTE: NO CONFLICTS WITH WELLS OR SEPTIC SYSTEMS. NEIGHBORING LOTS ARE ON A COMMUNITY WATER SYSTEM. Jul 27, 2022 4-BDRM HOME 10' UTI LIT Y EAS EM E N T10' T&E EASEMENTSHED 10' UTILITY EASEMENT RETAINING WALL 550 540 530 520 510 DECOMMISSION EXISTING TANK PER UPC AND REMOVE EXISTING TRENCHES TO REMAIN IN SERVICE EXISTING WATER LINE (APPROX) PROPOSED DECK MAINTAIN 5' SEPARATION FROM SUPPORTS TO SEPTIC TANK OR EXTEND SUPPORTS BELOW THE LEVEL OF TANK BOTTOM 5' SEPARATION Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221296, Rebecca Carroll, 07/28/22 Tract C Lot 2 10' T&E EASEMENT 10' T&E EASEMENTS 0 20 50 100 200 SCALE: 1"=60' Lot 7A 2.0'x' 2.0'x7.2' HOUSE DETAIL Scale: 1"=30' Lot 6 CHAIN-LINK FENCE / 53,1514 S.F. /T /`� WOODEN FENCE) V SEPTIC ER PORCH i CHAIN-LINK• J O 20' UTILITY EASEMENT r FENCE SEE HOUSE O' 122.5' DETAIL PAVER I I PATIO 12.4'x16.4' N ASPMA4T QRIV I�i� SHED \ %\4.� .. . ,^ - EK'AY O' J_ ?\G4 N \ RETAINING ' WALL Lot 5 \ L=30.07' \ TY R=50.00' EASEMENTS i\oR V E \ xz�'� NOTE: THIS LOT IS SERVED BY A / () COMMUNITY WATER SYSTEM. 3 PLOT PLAN _-- AS BUILT _X_ SCALE _ 1_ — 60__ GRID _ SW 2538Project No. ____2-2=4431A1---- 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates inc. (907) 522-6476 Phone (907) 522-4625 Fax 5QOF A ors kenOlangsurvey.com Y X44 Professional Land Surveyors o o �F, ........ . q 4 JonathanOlangsurvey.com S 0 1 hereby certify that I have surveyed the following described property: LOT 6, BLOCK 2, SPRING FOREST SUBDIVISION (PLAT No. 83-7) o *c) 49TH 0� Anchorage Recording District, Alaska, and that the improvements situated thereon are �'"' within the property lines and do not encroach onto the property adjacent thereto, that no Improvements on the property lying adjacent thereto encroach on the surveyed!7o z KENNET... LANG z promises and that there are no roadways, transmission lines or other visible 0 O o, easements on said property except as Indicated hereon. ti> �4 4Fo '•. LS -5202.•• gJO� Dated this the __kms___ Day of ----- )0 L"-�'" _. of Anchorage, Alaska .T— 044�'0F£SSIONAL �o It is the responsibility of the owner to determine the existence of any easements, D��OoNoo covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 Municipality of Anchorage Pageof2— DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: '(,0';5 Z PID Number: U 15- –� – Z� Name' Wastewater System: ❑ New gupgrade Address: I � ABSORPTION FIELD 11 (ubSr ae givf= 1�wcN. Lemsm Phone: .265- j�SZ, No. of Bedrooms: IKDeep Trench D Shallow Trench D Bed D Mound D Other LEGAL DESCRIPTION Soil Rating: b' Total Depth from original q rade: 7 1 ' � GPD/Sq. Ft. .5 Lot: / Block: Subdivision: Depth to pipe bottom from original grade: t Gravel depth beneath pipe i b �uazs7r :5•'..p- Ft. Ft. Township: ,- Range: Section: Fill added above original grade: Gravel length: t I •O, - Z 5 f Ft. Ft. WELL: ❑New El Upgrade 'NL Gravel width: 1 12 Number of lines: Distance between lines: _ Ft. '!"' Ft. Classification (Private, A,B,C): Total Depth: GL d To: Total absorption area: Pipe material: /}g-rm 03c. rLf rA f� 1 Y FL Ft. -7 SO SO. Ft. 2 F,6)0 Driller: ate Drilled: Static Water Level: Installer: A t Date installed: Ft. A pla,h� 5�.�.Cvrt,.t 6-Z`-1-`1Cs Yield: Pump Set at: Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES ISeptic� 0Holding DS.T.E.P. t To Septic Absorption Lift Holding Public/Private Manufacturer:'' Capacity in gallons: From Tank Field Station Tank Sewer Lines 11 V �, I -Z 5 G Well Zbh1 f Zo�i 4, ZS i Material: C .aTCG1j— Number of Compartments: z Watere 10c) + jeoce — -- -- LIFT STATION Lot + t Size in gallons: I Manufacturer: Line 60 Foundation I S •a„- � "Pump on" level at: "Pump o at: High water alarm at: Curtain,,l kmoc r Pump Ma el Electrical Inspections performed by: Drain 1 Un1E t4 Remarks: BENCH MARK Location and Description: 'T>o l ---Foe ej e pzG Ai ct (AT Assumed Elevation: oto • v i- t Iks�� r Inspections performed by:5 sFNGINEURINC Daate�s: 1st 17034 Eagle Diver Loop Road, No. 2U4 2nd ��-- 2-9 fid d �� T,?t ROBERT C. COWAN Eagle RIVBYr, Alaska 99571 Cr. 8801 Department of He h and�Luun ervices approval Reviewed and approved by. Date: 72-013 (Rev. 9/91) MOA 25 Permit No. SW960352 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 0 Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: LOT 6, BLOCK 2, SPRING FOREST S/D PID No. 015-321-24 72.013 A (Rev. 9/91) MOA 25 A B S'1 _ 28.0' .5' 2 34.5' 1 EXISTING TRENCH S .0' , BE U D IN THE FUTURE. DD D 36.0' 1 .5' D 1-1 35.5' 1 .5' D31_2 35.0' 1 3.0' /TH co C)2 22.0' 1 5.0' C 3 32.0' 6 .0' Ti M 1 31 .0' 6 .0' DI ILl � � A INSTALLED BULLRUN DNERTER VALVE (DV) / ST2 CO2 ° NEW TRE CH /Ml ° ST1 F D 1dr\� \� AI —IVATER LI E q �oJ N EXISTING 1250 GAL SEPTIC TANK VERIFIED 10-3 INEGRITY —96 \ i /ST�NC CgSeMeNT \ \ \ CO2 - .' STI JG.1' T2 ALE 1' = 40' II AL"RADE--____.wr1C0 __ luso qrl ,d�LER°7� 4 ......,,. EXIST. 1250 Gi L ,` ,., C) t S.T. 89.4' CO2 = 88.4' CO3 = 88.5' �5 .J!'� A P ROBERT C. COWAN �, MT1 = 80.4' F CE - 8801 Pa NO WATER POUND �, ` •,' :' 72.013 A (Rev. 9/91) MOA 25 C ap 5' PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE lf c1 DEPARTMENT OF HEALTH AND HUMAN SERVICES L�OrN'1 P.O. BOX 196650, 825 "L" STREET, ROOM 502 ,��11 q ANCHORAGE, ALASKA 99519-6650 SCD ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMITI-' PERMIT NUMBER:SW960352 S��S �C,tw n �2 - DATE ISSUED:10/17/96 DESIGN ENGINEER:,PT�AS EXPIRATION DATE•10/17/97 OWNER NAME:VERSEPUT TIMOTHY D & JANICE E OWNER ADDRESS:6011 WEST TREE DR ANCHORAGE, AK 99516 PARCEL ID:01532124 LEGAL DESCRIPTION: SPRING FOREST BLK 2 LT 6 LOT SIZE: 53154 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: V DATE: /0 / ! /7 C ISSUED BY DATE: HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSALSYSTEM DESIGN S&S� JtneeRrnq October 14, 1996 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS (907)694-2979 FAX (907) 694-1211 REFERENCE: Lot 6, Block 2, Spring Forest Subdivision Request you issue of a permit to upgrade the septic system serving the existing four bedroom house on the referenced property. A test hole was excavated and percolation test performed in the area of the proposed upgrade. The approximate location of the test hole is located on the attached site plan. At the time of excavation no water was encountered and after seven day ground water monitoring, the monitoring tube was found to be dry. Attached is the proposed upgrade design. This property is served by a Community Water System. We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by -the installation of -the proposed septic system. If you require additional information, please contact us. Sincerely, Robert C. RCC/gk Enclosure Cowan, P.E. MUNiUPALITY OF ANUjONAGE ENVIRONMENTAL SERVICES DIVISICN ocr J1996 IbE V ED 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 1" = 60' SITE PLAN SCALE o O --G mr_ m5v O-�i <I �o Ommx m ox o j D_ l e n o m CNK r <�3v r boy s 00 m�C:o �mr ro Off- �� N 3=<Z �.� ZDm �f v rA CJ DESIGN (T.1 Cn U r W 'Tl i/ (n i--1 M ��-1v c O Fri M m m rn C2 prj p p f^• -i 0J(A 0 yy--�� O C/)U F�,--7yy t•> —I wa .. ' A p rA Cn OHO~ Zy mDmN 0,0 mm<m �czm oDn.F9E; -^ ?zw =m TKO CLAN AN�<Om oZmD<mm m -z s� <m jrnJo M T z fD- L r-• r O 10' UTILITY EASEME14T ZA�c)m>m 0 r-_________________________ __________. __.___..._.______ mmmZ x -�-1 om �,y�,, / f �t>' ,H2{ omy.. D Ov mm CO mx m> =2 O (nN m� WDA 03(01 zZ c) � ( m m iGi y oOG7 C X/ /! / X O czi �_ jz G O r o C Y 7 CA O �� n m -In -IX P t �% TJ n,1I r / Z �0� 0> C-)Z--tz to O G SAm.. O ;ur!/ sari v o � m m -'C x (A "voMLz m z_c> in oy�mZ = — CO /O Z G-) 0 / A ^> ?u zzo.<LI) Q 01 ��W-�O Ol N c? / J O En Z n / NO-°OOW --u K p n a: -E c v M 0-1-Ioo➢ -1 r FrI 7_ A< 0r^ n rr r- D o S m O kx ii C1 M W Alf , 1 h ZEA Municipality of Anchorage a: 0*: DEPARTMENT OF HEALTH & HUMAN SERVICES v / k �`• p1i 1H•�r• i 11! iii ,IiNH1H�11,1 825 "L" Street, Anchorage, Alaska 99502-0650 jz SOILS LOG — PERCOLATION TEST r 1,. ,;. Y p` � ROBERT C. COWAN � �@ 0 <'. CE - 8801 + w PERFORMED FOR: "'I Ve x5.6 I'`/ DATE PERFORMED:`: J; `¢y �.- "4'%•' —� LEGAL DESCRIPTION: Lo / G QLIt "Z �� Township, Range, Section: IDEPTI-I SLOPE SITE PLAN 14- 15 4 15 a'c 16- 17 , 18- 19- 20 s 19 20 COMMENTS N /_ L4 Reading (F ET)Z Gross Time Net Depth to Time Water Net Drop [V K I0l' q 0 3 4 It 6 / r� Mn l f L 1- 4 i 10 _ WAS GROUND WATER Al ENCOUNTERED? 11 -,I f S V IF YES, AT WHATO L 12 DEPTH? P J E 13 dz c� Depth to Water After »�Zy Monitoring? Date: 7y�rY�cj� I 14- 15 4 15 a'c 16- 17 , 18- 19- 20 s 19 20 COMMENTS N /_ L4 Reading Date Gross Time Net Depth to Time Water Net Drop [V K I0l' q 0 rvlr Ll J " o S' PERCOLATION RATE� (minutesnnch) /FERC HOLE DIAMETER L/ TEST RUN Bv ETWEEN i_¢ A FT AND `_� /3- FT PERFORMED BY:S & S ENGINEERING aye rver Oop Od O. 2 CERTIFY THAT THIS TEST/WAS PERFORMED IN IA ACCORDANCE WITH B401bTifthlia"b#W109N7GUIDELINES IN EFFECT ON THIS DATE. DATE: // Y r C 72-008 (Rev. 4/85) Name Address _-- b (9 - t I Phone(s) D f7 J ry xx LEGAL DESenIPTIDN Lol _ Bbckn Subdiviys�ionn � _ Townsnlp, Range, Seclron TANKS ❑ SEPTIC ❑ HOLDING Manwacluler—i� Capacity in gallons __� xisT7NL _ Material No of Compartments - — TYPE OF SYSTEM I;Q TRENCH ❑ BED ❑ W. DRAIN ❑ OTHER Depth to pipe bottom Irom Total depth from original grade original grade F7 � � FT Pill addetl above original grade Gravel depth beneath pipe -7 Ft / FT Gravel length Gravel width FT Tot[ �P absorption area Distance between lines - 80 FT FT Number of linesSoil rating -- Pipe material SOFT-____ Installer x y) Date Installed WELLS ❑ PRIVATE ❑ OTHER (Identity) Classihcrtmn A.13,C) � Total DepthCasetl to -- - - - FT FT Installer Da -10 II1Stalletl' MUNICIPALITY OF ANCHORAGE V P D ITMENT OF HEALTH AND HUMAN SER eS Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL- INSPECTION REPORT DISTANCES SEPTIC ABSORPTION WELL TANK _ FIELD _ Permit No. No. of Bedrooms — > r2 (J 20-0 I REMARKS: � a" bb WELL LOT LINE C) FOUNDATION % AS -BUILT DIAGRAM (Show location of well, septic system. property lines, foundation, driveway, water bodies, etc.) Scale: % I'- 30 r Inspections Performed by. Date. Z// / 17 a certilit that this inspection was perlormetl according to all Municipal and State g idelines in ellect on this date: O �( Heallh Department Approval:-� _'�y"';tee—r-�✓ Date:. �' g I I I 1_ 1 ,1 E- ENGINE.EfTS SEAL r i'4't yesas ems° t fi certifv that: am {amiliar with the requirements ersand we1ls as set forth by the Municipality o� Anchorage (MOA> and the State o� Alaska. 2. I wili install the svstem in accordance with all MOA codes and regulations, and in compiiance with Lhe design criteria o{ this permit. J. T wili adhere to a]l MOA and State o� Alaska requirements �or the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearhy lot. lF A LIFT STAT1ON lS INSTALLE0 IN AN AREA COVEHED BY MOA BUILDING CODES, O1EN (1) AN ELECTRICAL PERMlT AND INSPEC[ION MUST BE OBTAINED; (2) AS- BUILTS WILL NDT 8E APPROVED WITHDU[ AN ELECTRICAL T' 1\1 REPORT; AND (3) THE ELECTR1�AL W�kK MUST BE U�NE D lCENSED ELECTRIClAN. APPilCANT: GORD(]N |��TCHINGS ` ISSUED BY � ��it DEPARTMENlOF HEALTH AND ENVIRONMENTAL PROTECTlON 825 L STREET, ANCHORAGE� AK 995O1 264~4720 it [I 't�� K� it it it Kit��- PERMIl ND: 870003 UP6RADE DATE lSSUED: 01/O2/87 APPLICANT: GORDON HITCHINGS ADURESS: 6011 WEST TREE ANCHORAGE, AK 99516 CONTACT PHONE: 279�3916 LEGAL DESCRIP : B SU{IvT��IO �LU, Nr��U�R�N8"FOREST� `' ' ` ` `�. ` ' �`/L8T:`6/� ` �`.K:'�� SECTION: 33 TOWNSHIP: T12N RAN|F: R3W ^�y LOT SIZ 000 (SQ.FT. OR ACRES> certifv that: am {amiliar with the requirements ersand we1ls as set forth by the Municipality o� Anchorage (MOA> and the State o� Alaska. 2. I wili install the svstem in accordance with all MOA codes and regulations, and in compiiance with Lhe design criteria o{ this permit. J. T wili adhere to a]l MOA and State o� Alaska requirements �or the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearhy lot. lF A LIFT STAT1ON lS INSTALLE0 IN AN AREA COVEHED BY MOA BUILDING CODES, O1EN (1) AN ELECTRICAL PERMlT AND INSPEC[ION MUST BE OBTAINED; (2) AS- BUILTS WILL NDT 8E APPROVED WITHDU[ AN ELECTRICAL T' 1\1 REPORT; AND (3) THE ELECTR1�AL W�kK MUST BE U�NE D lCENSED ELECTRIClAN. APPilCANT: GORD(]N |��TCHINGS ` ISSUED BY � 3 W �11,v1'=✓9 20ANCHORtAGE,EA ALASKA CONSULTING ENGINEER TELEPHONE_ (907) 279-3916 CLAIR RAMSEY JACK WHITE CO DECEMBER 12, 1986 3201 C STREET ANCHORAGE, ALASKA 99503 SUBJECT: LOT 61 BLOCK 2, SPRING FOREST GORDON HITCHINGS RESIDENCE HOME EQUITY Gentlemen; On December 11, 1896 I utilized a backhoe and exposed the ends of the drainfield on subject property. The attached sketch shows what was found. As can be seen the distribution pipe was disconnected from one standpipe. The Tee was found approximately 24 inches above the level portion of the distribution pipe. From what could be seen from the two excavations we dial, a total of five feet of sewerrock was installed in the trench, a total of seven feet was specified. The sewerrock immediately under the distribution pipe was heavily contaminated with silt from the trench excavation. I would estimate that the silt content of the portion of the rock we could see was in excess of 25 %. The installation permit and design of this septic system was based on a soil rating of 150. This was a rating obtained from a visual inspection of a test hole located at the south west corner of the lot. The soils exposed at the trench could not be classified as 150. We therefore performed a percolation test, the result of which is attached. Based on our investigation the soil must be classified as silt with a percolation rate of 20 min.per inch or a design value of 225 sq. ft. per bedroom. The existing trench can not be utilized, a complete new repla- cement system must be installed, a permit must be obtained from the Municipality based on a revised design which will depend on soil and groundwater conditions, land areas available and applicable set back distances. The Engineering cost of obtaining the permit is $600.00 However in this case, some of the soil information has already been obtain as stated above. The design and permit can be obtained for $ 430.00. The system must be inspected during installation. The fee for this service is $ 200.00. I will obtain two fixed cost proposals to install the system when the design has been approved by the Municipality. Yours Tobbb n p kland P.E. N❑TESi COMMUNITY WATER RESIDENCE VACANT I10 FT, TANK PUMPED 12/10/86 (UTILITY REPLACE TOPSOIL AND REGRADE I EENT , AFTER SPRING BREAKUP INSTALL 2nd, CLEANOUT ON TANK OF AZ'q J it LOT 6 .1P,•• + I I BLOCK 3 �o°�h•' ^�••'•9 53,425 SQ,FT, Alf. T H ITEsr �•��✓i •.....• •. •�.� HOLE EXIST. �O-P . JUNE 25, 19IL •O HTEST OS£ /TANK +��`FS •..... • •aG`C.v�� o \ �,�4�,NA� N 4 -BE OOM �I �\ RESID CE ' v PROPOSED �� 6011 WE TREE 85' TRENCH .` 50 100 150 200 250 300 GRAPHIC SCALE V = 100, CLEAN OUT rem TOBBEN SPURKLAND P,E, 203 W 15TH. AVENUE ANCHORAGE, ALASKA MONITORING TUBE TOTAL LENGTHj 85 FT LOT 6, BLOCK 2 SPRING FOREST CLEAN OUT >w Ma U SEPTIC SYSTEM DESIGN DECEMBER 23, 1986 �O 203 W. 15th "C" SUITE 203 TING ENGINEER V�� ANCHORAGE, ALASKA 99501 — TELEPHONE: (907) 279-3916 SEPTIC TAKII,/ EAST STgtCpPlPE Ff-1 C6�NIMD� WE" B�0K1=N I STAND PlP1 II 77- I, Ho2ksomrAL- l'IPF LITH S1.up6C a . SOIL LyiFl S LViAS Fou1.lk) pL_UC T (o E�K2 SPRItdC� Fn2�sj DSC 121 1R&b �V I4(-TDAL 404ATIOYI ✓ 4 B o d r� ® � rte. n• � N O o �.�`r a Ew c. ®� �` � � a e `+s+ Q9 O (J6� a O �1 � Q O d � Qp Qn l^ lD ca Q r+ a "C Y a✓ s ,m p A •O .e� _B ep d c� Ali/s/1 --T I, Ho2ksomrAL- l'IPF LITH S1.up6C a . SOIL LyiFl S LViAS Fou1.lk) pL_UC T (o E�K2 SPRItdC� Fn2�sj DSC 121 1R&b (ENGINEER'S SEAL) o Municipality of Anchorage Y DEPARTMENT OF HEALTH & HUMAN SERVICES f' ; 825 "L" Street, Anchorage, Alaska 99502-0650 s' ` q r t1 - J` SOILS LOG — PERCOLATION TEST ; , yll " JUNE- 25, L9j1 PERFORMED FOR: GOP=,Oi I 4 i -F c{41 (m.% DATE PERFORMED: LEGAL DESCRIPTION: L{9J�( �� SpRJ�1r'� Por2ss7Township, Range, Section: j �aM r ��l SEC 33 I t� SLOPE) SITE PLAN 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS — PERFORMED BY �z WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT L DEPTH? O P E Depth to Water Alter (2 Monitoring? ` o � Date: Grass Reading Date Time Net Time D th i rr 'n'..'..r Net Drop r 7p 70 0 7.5 ---- �o PO -- 3n ro 7• S 3o 7 s OMNI Grass Reading Date Time Net Time D th i rr 'n'..'..r Net Drop r 7p 70 0 7.5 ---- �o PO -- 3n ro 7• S 3o 7 s PERCOLATION RATE _i (minutes/inch) PERC HOLE DIAMETER r/ 7 TEST RUN BETWEEN 7 FT AND 2, FT ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN 72-008 (Rev. 4185) Lf�� CERTIFY THAT THIS TESTI WAS PERFORMED IN ON THIS DATE. DATE: lk�� MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264.4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE XNEW ❑UPGRADE MAI LINGAil ESS ) / LEGA} DE CRIPTI N LOCATION NO. OF BEDROOMS 41 v DISTANCE TO: Well Absorption area Dowelling ''''11 '�"' Nt) PERMIT NO. LL F Z Manufacturer Q �) = Ma -'aJ�� / No. of,ompartments (a Liq. ca achy, n gallons r' S IF HOMEMADE: Inside length Width'' (� Liquid q depth O 0 JZ DISTANCE TO: Well Dwelling PERMIT NO. SFQ- Manufacturer Material Liquid capacity in gallons j w DISTANCE TO: Well ao Foundation Nearest lot�,liite PERMIT NO. Lu Z 2 w ~ No. of lines ! Length f line Tot I le of lines r Trench 'dIh inches Distance lies - H Top of tile to finish gra ! Material beneath the Total effective absorption area inches 6-3 ui Length Width - Depth PERMIT NO. a h wa LLI -type of crib Crib diameter Crib depth Total effective absorption area w DISTANCE TO: Well Building foundation Nearest lot line w Class Deptlt Driller Distance to lot line PERMIT NO. w i: DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MAT E R SOIL TEST RATING DU � INSTALLL-� / pl REMARKS i p t � � APPR VED DATE LEGAL MUNICIPALITY OF ANCHORAGE Department Health and Environment& -)rotection 825 y Street, Anchorage, AK. X9501 264-4720 Permit # # HANDWRITTEN PERMIT W€1":I�tBR ON-SITE SEWER PERMIT Applicant: �('�J a� Mailing Address: Location: _ Phone Number: 3, Legal Description: L�12%'6;1 Type of Soil Absorption System Is: Trench: �"'l Drainfield: Maximum Number of Bedrooms: 0 ze: Seepage Bed: Holding Tank: Soil Rating(sq.ft/br) The Required Size of the Soil Absorption System Is: d, DEPTH /9- _ LENGTH C� k GRAVEL DEPTH _ WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). l) REQUIRED SEPTIC(HOLDING) TANK SIZE = Grr ? GALLONS # Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. # # TWO(2) INSPECTIONS ARE REQUIRED # Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. # PERMIT EXPIRES DECEMBER 31, 1 9 v # I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the,re�sidence is remodeled to include more that bedrooms. Signed,.�s r — �.. Issued by: X11[ ` -'4 pplicant Date: SWP/024(1/81) ��c)c Po o �( SO#G �- MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 0 PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264.4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: & k brfAes.(4 DATE PERFORMED: J"'J c 3 I1183 LEGAL DESCRIPTION: L 33T 11 N R-3 W Alt--) N Cl Q,3 07 `�— Q P� SLOPE SITE PLAN 1 2 a� M a 5 6 (rJP' .�;ne C1Ca4 SAgd CIL 1 8 . 9 10- Date Gross 11 , Net 12 Time 13 Water Drop 14 �.. OF �Al�4 15 ��.... 16 .. r 17 ,;, + eroy C. Reid, Jr 0 No. 2251-E 18 `4 1p90FESG ►��N 19 yo WAS GROUND WATER S ENCOUNTERED?_ L O P _. IF YES, AT WHAT E DEPTH? ,)w3eading Date Gross Net Depth to Net Time Time Water Drop I�210 r 20 PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND --_ FT COMMENTS r.,I I -�r0nt i '12 —�b 1 6 5 rak d /� ISS ❑ �b�, _ PERFORMED BY: arm CERTIFIED BY: DATE: 72.008 (6/79) D�,� r�u�,�. i,_s _ Municipality of Anchorage y ") roOn-Site Water and Wastewater Program zr r midis • : • • °- "Ark(907) 343-7904 : • ' 44 hcu ti Certificate of On-Site Systems Approval L�8 L g Act' i 6 8 Parcel I.D. 015-321-24 Expiration Date: j ( ` I t_ • 1. GENERAL INFORMATION Complete legal description Spring Forest, Block 2, Lot 6 Location (site address) 6011 West Tree Dr. Current Property owner(s) Harold & Nancy Boschetto Revocable Trust Day phone Mailing address 1121 Old Jerome Hwy. Clarkdale, AZ 86324 Real Estate Agent Day phone 2. TYPE OF DWELLING: Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual Individual Water Storage ❑ Holding Tank El Community Class Well ❑ Community ❑ Public Water System Public Sewer ❑ WaiverNariance request for: Distance: err gYe • Received • • - 414Date: i - l COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ �`�o rWaiver Fee $ Date of Payment .3l7A ll' Date of Payment Receipt Number 013L3 Receipt Number COSA# 65Gk ?I1(5— Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances,and regulations in effect at the time of installation. In conducting an adequacy test,I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations.The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition,ground water levels that may fluctuate during the year,and the water usage of the family being served by the system.These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system,nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone Date 3/15/2018 OF A(„Qs�i� 114 6. DSD SIGNATURE System#1 Approved for bedrooms •.S}even '. 'annone• System#2 Approved for bedrooms CE-8149•. �� Disapproved � `Pt? •••••.64\- Conditional approval for bedrooms, with the following stipulations: t � l t S J 2 C C. \ (AAAI Pct.✓( l9 Lt Pt ki. ,Lifte1 a S i c—rovvkI� 12_0 Aiect., c0 (cl 014-6ITE F WNTER AND z =.a WAgTEWaTLR o • pR°GRAM By: . L ri / Original Certificate Date: `q"/ l The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other )C COSA blue sheet f c If more than 1 septic system is on the lot: COSA Checklist# 1 of 1 Structure served by this system 1 Certificate of On-Site Systems Approval Checklist Legal Description: Spring Forest, Block 2, Lot 6 Parcel ID:015-321-24 A. WELL DATA Well type Public If A, B, or C provide PWSID# AWWU Well Log (Y/N) Date completed _ Sanitary seal (Y/N) Wires properly protected (Y/N) Total depth ft. Cased to ft. Casing height(above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate mg/L Arsenic ug/L Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 1/26/1984 Tank size 1,250gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout(Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 10/14/2017 Pumper McDonald's Pumping Services C. ABSORPTION FIELD DATA Date installed 2/10/1987 Soil rating (g.p.d./ft2 or ft2/bdrm) 268 SF/BR System type Deep Trench Length 86 ft. Width 2 ft. Gravel below pipe 7 ft. Total depth *10.7 ft. Eff. absorption area 1,204 ft2 Monitoring tube Y Depression over field N Date of adequacy test 3/6/2018 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 10/0 in. Water added 600 gal. New depth 13/0 in. Elapsed Time:_120 min. Final fluid depth 10/0 in. Absorption rate >= 600+ g.p.d. N Any rejuvenation treatment(past 12 mo.) (Y/N &type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ On adjacent lots 100+ Absorption field on lot 100+ On adjacent lots 100+ Public sewer main 75+ Public sewer manhole/cleanout 100+ Sewer/septic service line 25+ Holding tank 100+ Animal containment areas 50+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Absorption field 5+ Water main 10+ Water service line 10+ Surface water 100+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water main 10+ Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS Tested system that appeared in use. System installed 10/29/1996 was dry. *Monitor tube only reaches 6 feet below lateral line. Water depth based on record drawing. G. ENGINEER'S CERTIFICATION ...�' OF ALAN I certify that / have determined through field inspections and review of Municipal records that the above systems are in p"*; TI-1 I\ •,* 0 conformance with MOA COSA guidelines in effect on this date. ce Steven Pannone Engineer's Printed Name i • Slteven . Pannone 3/15/2018 6.0:• CE-8149 •&/. Date9N... r COSA canary sheet_2-6-15.doc hi/- v -TR, C- . ,,s! . ,6 ��102 la 6 A.2 f • 004 A ob V.• z 0 W- •i i i -7- In Li tn, ) MSI 1411 Zsi N. SCALE % 1 0 -r, O 1 h �Co I , /• iLLI �. s I ,o 44 k%.91 67• •9 o '�4 ''�„ . s,' i.--ice :. , Recerf 6+7-16 �.`�(! �' " -, p,oo... AS-BUILT NO CORNERS� S SET THIS DATE K IV 1hereby certify that I have performed a Mortgagee' per tion ^'.'- ' ' t 1L'41-k � of the following described property: 1-0 T 6, 8•LOCk Z) "Ar..•4 •. 4WD I $F'RPr#j Fops,r^ S i91 . w •"F-_.f-- -1,t -,-k 3 Anchorage Recording Precinct, Alaska, and that the if improvement's situated thereon are within.tha property lines and :'U't,4/ .•A do not overlap or encroach on theproberty lying adlacentthereto, �e that no improvements on properly lying adjacent thereto ,r %-rd'-ra,` a encroach on the premises in question and diet there are no • �frt.1. -w, ,•=.--... 42,5 S.•`•',,k.' roadways,transmission lines or other visible easements on said kN';; ,„'''',,,...,••••••"„,4•••• , s •property except as indicated hereon. 't t` oDated at Anchorage.Alaska EASEMENTS OF RECORD,OTHER THAN this az'74A day of NaUeM6ER 19 /4' THOSE SHOWN ON THE RECORDED FRED.WALATKA&ASSOCIATES PLAT ARE NOT SHOWN HEREON.LA..,i cr/ BR= (907)248-1686 Engineers and Surveyors. Parcel I.D. 015-321-24 -7 �. a.rrl (� JUN 2 8 2016 Municipality of ranch®rap On -Site Water and Wastewater Program (907)343-7904 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Expiration Date: b - 10 ` 1 O Complete legal description Spring Forest, Block 2, Lot 6 Location (site address) 6011 West Tree Dr. Current Property owner(s) Harold & Nancy Boschetto Revocable Trust Day phone Mailing address Real Estate Agent 1121 Old Jerome Hwy. Clarkdale, AZ 86324 Relocation Company 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individualx❑ Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System E Public Sewer ❑ WaiverNariance request for: Received by Date: -7/ 7/tf COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ S2 4 . O O Date of Payment__ 621 g�l�e Receipt Number_ COSA# OR'16 /�2 Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE System #1 Approved for �(_ bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for Date 6/27/2016 bedrooms, with the following stipulations: BY: m f L^^ Ear/ Original Certificate Date: ! ` The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered imthe State of Alaska.. The Municipality of Anchorage is not responsible forerrors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Septic System Advisory Well Flow Advisory COSA bine sheet f c Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the lot COSA Checklist # of Structure served by this system 1 Certificate of On-Site Systems Approval.. Checklist Legal Description: spring Forest, Block 2, Lot 6 Parcel ID: 015='321-24 A. WELL DATA Well type public If A, B, or C provide PWSID # AWWU Well Log (WN) Date completed Sanitary seal (Y/N) _ Wires property protected (YIN) Total depth ft. Cased to ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level Well production 9-p.m. g:p.m. WATER SAMPLE-RESULTS: Coliform colonies/100 mL Nitrate mg/L Arsenic ug/L Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA -- TankType/Material Septic/Steel Date installed 1/26f1.984 Tank size 1,250 nal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (�Y/N) Y Depression over tank (YIN) N High water alarm (Y/N) N Date of pumping �Y 7/ 1 b Pumper A [to N1, 6 Er- V i t 6 5 T- /Vc C. ABSORPTION FIELD DATA Date installed 211 011987268 rating (g:p.d./ftz or ft /bdrm) 268 SF/BR System type Deep Trench Length 8Y_ ft. Width, 2. ft. Gravel below pipe 7 ft, Total depth 0'7 ft - Eff. absorption area 1,204 ftz Monitoring tube Y Depression over field N Date of adeq t 'Results (Pass/Fall) C1 ao1 s Pass 4., bedrooms ; uacf�test ., For _ Fluid depth inIabsorption field before test 32 in.. Water added 629 gal. New depth 44 in. Elapsed Time: 120 min. Final fluid depth 32 in. ' Absorption.rate >= 600+ g p,d Any rejuvenation treatment (past 12 mo.) (YIN & type) No. If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. _ "Pump off' level at in. High water alarm level at in, Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic.tank/lift station on lot 100+ On adjacent lots 100+ Absorption field on lot 100+ On adjacent lots 100+ Public sewer main 75+ Public sewer manliole/cleanout'100+ Sewer /septic service line 25+ Holding tank 100+ Animal containment areas 50+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ property line 5+ Water main 10+ Water service line 10+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water Service line 10+ Surface water 100+ Curtain drain 50+ Wells on adjacent lots 100+ Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle. storage 10+ F. COMMENTS. 1. Tested system that appeared, in use. System installed 10/29/1996 was dry. *Monitor tube only reaches 6 feet below lateral line. Water depth based on record drawing. G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections ,and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven Pannone Date 6/27/2016 COSA canary sheet_2-6-15.doc I 0 m Z 6) m 0 1498 EE.IW el GMP I BTI, J +00 IL F.ow S 2ppD STA Zot 0 TOP 17 .7 q� I T., �M I O�Sls OR �TATIC�lwl �o 2, � � A .1",1 341 4G R 09 '4E41 31 "J, 54Z STn 2+45'4 END z+F CMP INV=5Ao17 57. 10, 73.,& SEE, LL W�TCH —111E +1 � "T'Rml, Pi �v - 55501 i 0 1 ol 5rA. 40 6840C. BREAK moo LV rLINE 'SEE SWr. ja 5) V. .60&, B + 0 0 I -- -1 6, avyv V1, - IN52,80 . ......... II �UII STP. Ili 00 PI VG PI CLEW= G I ............. B I z 6,13 CUzve mt-EV- $1 . ........ ........ of rA i STA. />+40 GRADE BREAff6 a —I&Y-543.30 ....... 4 : STA: FJ-t5V A? .541 S7A 16+50 PlIC P, SL.V. 5 74 Y.O=1LQVI 54111 STA. /9+90 6RADEBREbIL JNV.540.0 . . . . . . . . . . . . . ........... 0 E45 z2 _SIA 20 111 59 PROPERTY LINE .ZO {'93.66 6 v G -a SLO111-1 0 Z m M M 204 70 --7- r EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HERiEON.tq"T�uj $E i1iI/ L (/ AS -BUILT NO CORNERS SET THIS DA7E �f r I hereby certify that I have performed a MortgageaXnspectlon of the following described property: LOT 6 $LOUD Z� s Pk> Aj6 rC r-aS,, - 154/90. Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within_tho prgpertyaines end do not overlap or encroach on the property lying adjacent thereto, that no improvements on properly lying adjacent thereto encroach on the promises in question .and that there are no roadways, transmission lines or other visible easements on said proparty except as indicated hereon. Dated at Anchorage, Alaska this /(a f{ day of /V,!*EMGEAZ 19%(d FRED WALATKA & ASSOCIATES (907) 248-1666 Engineers and: Surveyors. Municipality of Anchorage • Development Services Department Building Safety Division Onsite Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 &-t.,y i✓trfe, CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D. 015-171-74 COSA # n1 P/N 7 1. GENERAL INFORMATION Expiration Date: 2— l Y 1 O 7 . . .. C :414.1 A:] 14TOw.1111111 X $111 Current Property owner(s) CARRAt IGH PANAM( TA Day phone 227-1140 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class Well ❑ Public Water System Day phone Day phone TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank ❑ Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent' professional civil engineer registered In the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm . 1 FNGINFFRING, INC Phone9964111 Engineer's Printed Name KENNETH M DUFFUS Date Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, KND can not give any estimate of how long a system will function satisfactory for current or future occupants or can KND guarantee that no unseen encroachments, deficiencies or discrepancies exist. 5. DSD SIGNATURE Approved for _ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: COSA Checklist X Arsenic Advisory Septic System Advisory Well Flow Advisory Nitrate Advisory Maintenance Agreements Supplemental Engineer's Report Other By; Original Certificate Date: — 7 " 61! (Rw 11�V5) Municipality of Anchorage • Development Services Depairtmen Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street l P.O. Box 196650 Anchorage, AK 99519-6650 f www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: SPRING FOREST 82` LS Parcel ID: 01 5 - 3 21 - 2 4 A. WELL DATA Well type PUBLIC Date completed If A, 6, or C provide PWSID # Well Log (Y/N) Sanitary seal (Y/N) Total depth ft. Cased to ft. FROM WELL LOG Date of test Static water level Well production WATER SAMPLE RESULTS: ril 9.p -m. Wires Properly Protected (Y/N) Casing height (above ground) in. AT INSPECTION ft. Coliform colonies/100mL Nitrate mg/L Other bacteria oolonies/100 mL Arsenic: mgA Date of sample: Collected by: B. SEPTICIHOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 1126/1984 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) X Foundation cleanout (Y/N) Y Depression over tank (Y/N) lj High water alarm (Y/N) 1LDate of pumping 2/3/06 Pumper McDonald's C. ABSORPTION FIELD DATA Date installed 10/29/199 Soil rating (g.p.d.Alr or fefbdrm) 0.8 System type _Deep Trench Length eft. Width _Z&ft. Gravel below pipe JLft. Total depth 14.5 ft. Eff. absorption area 7S0 ft' Monitoring tube Y Depression over field h Date of adequacy test 2/3/06 Results (Pass/Fail) Pass For A- bedrooms Fluid depth in absorption field before test 32.4 in. Water added 1000 gal. New depth 80.4 in. Elapsed Time: 1260 min. Final fluid depth 46.8 in. Absorption rate >- 600+ g.p.d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date ----- D. LIFT STATION Date installed Size in gallons Manhole/Acoess (Y/N) 'Pump on' level at in. 'Pump off" level at—in. High water alarm level at_in. Datum Cycles tested Meets alarm & dram requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service line On adjacent lots On adjacent lots Public sewer manholelcleanout Holding tank Animal containment areas Manurelanimal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/MOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field s'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10' + Water Service line 101+ _ Surface water 11001+ Driveway, parkinglvehide storage 3_ Curtain drain 50'+ Wells on adjacent lots 200'+ F. COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that 1 have determined through field inspections and review of Municipal records that the above systems are in '" conformance with MOA COSA guidelines in effect on this �9.a.. .�• .}•» date. Engineer's Printed Name KENNETH M. DUFFUS Date 02/06/2006 COSA Fee Date of Payment ;L`lp — O (o Receipt Number (Rev. 1IM5) Waiver Fee $ Date of Payment Receipt Number I z �O(.IPI'• #} , .1 ja a Kar! OOW11a' �/ • '., {3646 r / I 7 cf �«�� .7e OIr C✓!IN Jii4ii c-' 1 Val.✓: ►7uv fp ,p z-,ra=y .N or LL 001, J would Ithe t is istence of any eaiity of the owner to determine I&CM1 ,ements strictions which donotappear•on'theants recordedrsub- division plat. Under no circumstances should arty �NOTE data hereon be ..used for constructign or for estab- EASEMENTS OF ACCORD, OTHER THAN THOSE fishing boundary-or fence lines. The surveyor taker SHOWN ON THE ACCOR0E0 PLAT, .ARE NOT responsibility for the initial transactiononly. SHOWN HEREON. )QT� 6 BLOCK �� G 1ECEND , 144E8 tAP NOMVMENT IRON PIPE ANCHORAGE RECORDING DISTRICTLAT No El 040 11 TACK 111114)fOR.INO - 'NviED` SY: LUWUNG a AASSOCIATES 1426 HYDE/? STREET 01 ANCHORAGE ALASKA 99501 QATC1 `� BYJ SCALE: ///_ / WORKOAOER: FIE B00 6R70: 255R1 MAR 11 '93 15:05 -• ?"rN'�1��;!{� r .:+."i+�i•:� I 4275 I'AGE. 907 216 002 MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.U. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # d 1 .S- -3 (I - " y HAA # 1. GENERAL INFORMATION Complete legal description Lo 7 - 13za L, j< :Z S)0/RcA/G 'C)2eSI 5% Location Location (site address or directions) 0 1 r w 6- s r TR 4. 91t Cls�r G Property owner I l r'1 y�%�s� A6'i Day phone D 6J —/CS`D_ G e)II WwSi 4,—cP0,44-c-6 , AIC "IS'/4C Mailing address Lending agency Mailing address Anant A AArocc. Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 1� �. 3. TYPE OF WATER SUPPLY: Individual well Community well X Public water Day phone Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site —X Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev.1/91) Front MOAM21 5. STATEMENT OF INSPECTION BY ENGINEER. l-1 0 As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. S & S ENGINEERING Name of Firm 17034Eacgle River I aop Road 1n 9 Phone �' `i Address Eagle River, Alaska 99577 Engineer's signature DHHS SIGNATURE 6Nj , - Approved for Z y bedrooms. Disapproved. Date I? /'y ( 7,6 .�. n •}.pl :er�F1 ROe�FRT 9'i" GOjIJclr�' Iry lb Conditional approval for bedrooms, with the following stipulations: Additional Comments WTIC The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-M (Rev. 1/91) Back MOA #21 N UNILIPALI FY OF ANC HOkAUe ENVIRONMENTAL SERVICES UIVISlolq NOV 0U �ssf; • � Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES RECEIVE Environmental Services Division 325 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: 6 6'-K ,✓ oXc, sr- Parcel 1. D.: O A. WELL DATA Well type a h s s If A, B, or C, attach ADEC letter. ADEC water system number a 1 3 ..S G Log present (Y/N) Date completed Total depth Cased p to Casing height (ab gr nuo d) Sanitary seal (Y/N) Wires pr of y protected (Y/N) :FROM WELL LOG AT INSPECTION Date of test Static water level Well production 9 -P.M. g. p. m. WATER SAMPLE RE,StJ S: Coliform �� Nitrate Other bacteria D� of sample: Collected by: B. SEPTIC HOLDING TANK DATA Date installed 1 1,x(dS y Tank size / 0 Number of Compartments Cleanouts (,ON) �Yg -s Foundation cleanout (i�JN) Y #-T Depression (YIN) 1" 0 High water alarm (YA@I, M' Date of Pumping c `f G Pumper A s IVwc f C. ABSORPTION FIELD DATA Date installed fo `/ _ Soil rating ' rc Lgped./�or ft2/bdrm) C� - System type �N Length 7 ' g Width a • ? Gravel thickness below pipe Total depth Effective absorption area 7 ° "_Z Monitoring Tube present O ON Yt S Depression over field (Y/gQ iv v Date of adequacy test ��'� _ N �✓ Results (Pass/Fail) Fluid depth in absorption field before test Immediately after_ gal. water added (in.): _ Fluid depth � a inutes later: - Absorption rate = ___ g.p.d. e treatment (past 12 months) (Y/N) 72-026 (Rev. 3/96)" If yes, give date D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at' Cycles E. SEPARATION DISTANCES "Pum *Datum SEPARATION DISTANCES FROM WELL ON LOT TO Septic/holding tank on lot Absorption field on lot Public sewer mai service line Size in gallons "Pump off" level at` AJ) A- — C o,H 14U'V r r Y 1"/1 "'/ On adjacent On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC HOLDING TANK ON LOTTO: Foundation s— ¢ Property line Go Absorption field S l H Wells on adjacent lots a ° o Water main/service line &)- Surface water/drainage 7 0 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: � Property line 10 Building foundation If Surface water Curtain drain KC ot�W Water main/service line a. Driveway, parking/vehicle storage area , Wells on adjacent lots i F. ENGINEER'S CERTIFICATION I certify that I have determined thru" field inspections and review of Municipal rec e� systems are in conformance with MOA HAA guelines in effect on this date, p'A,.• """"�t�tr Signature Engineer's Name r,Z ROBERT C. COWAN Date 1 tt / �l G d!P CE - 8801 HAA Fee $ c 6b Date of Payment ` Receipt Number 72-026 (Rev. 3/96)" Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # U') - "D 1- -ALA 1. GENERAL INFORMATION HAA it )1 f- `) 3L(l 1`� Complete legal description Lot 6; Btock 2; Spn.ing Fonea.t Subdiv.i.6 ion Location (site address or directions) 6011 We4.t Tnee Dwi.ve, Anehonage Property owner Naomi FuUeA Day phone 346-8246 Mailing address 6011 West Tnee Dive, Anehonage, Ataska 99516 Lending agency Day phone Mailing address Agent Rick Fu,PyL / Vista Real Estate Day phone 562-6464 Address 3000 "C" Stneet, Anehonage, Ataska 99503 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water XXX NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA U21 5. G. STATEMENT OF INSPECTIOI BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. S & S ENGINEERING Name of f=irm �,034-Eagfe-Riper Loop-Road-No,2@4Phone Address Eagle River, Alaska 99577 Engineer's signature DHHS SIGNATURE _a_4� Approved for Disapproved. Conditional approval for Additional Comments bedrooms. %I1TtC Date bedrooms, with the following stipulations: Date __ � � I_. The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA M21 • Municipality of Anchorage Department of Health & Human Services M� HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LoT (o (3GOcK Z SPIz/N& Fczex Parcel LD 51D A. WELL DATA Well type A If A, B, or C, attach ADEC letter. ADEC water system number z 13 5-6 4 - Log present(Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well flow Pump level Date completed Cased to FROM WELL LOG Driller ing height Wires properly protected (Y/N) 9 -p.m AT INSPECTION SEPARATION DISTANCES FROM WELL TO: ) Septic/holding tank on lot — �� '� ; On adjacent lots Absorption field on lot 4— ; On adjacent lots Public sewer main Sewer service line WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate Public sewer manhole/cleanout um tank Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed j Z(D 004 Tank size 1 ZOO 6NL Compartments Cleanouts CYN) YES Foundation cleanout y5S Depression (Y1 'ye High water alarm (Y/�}I w Alarm tested (Y/N) NlA Date of pumping l Z IZ 3 i Iq2— Pumper �-r HWE SEYL✓<GES ✓ SEPARATION DISTANCES FROM SEPTICfaN)t�TANK TO: Well(s) on lot NO.vE //°�YtEt On adjacent lots ZOCJ '� Foundation To property line Absorption field 5+ Water main/service line Surface water/drainage 110,o " loa(UW ) 72-026 (Rev. 7/91)Front -*PEi2 Z110187 UJSP&77W /Z P0&vLT CONTINUED ON BACK PAGE b x n rM g.p.m. cnn 0 oG) x Cleanouts CYN) YES Foundation cleanout y5S Depression (Y1 'ye High water alarm (Y/�}I w Alarm tested (Y/N) NlA Date of pumping l Z IZ 3 i Iq2— Pumper �-r HWE SEYL✓<GES ✓ SEPARATION DISTANCES FROM SEPTICfaN)t�TANK TO: Well(s) on lot NO.vE //°�YtEt On adjacent lots ZOCJ '� Foundation To property line Absorption field 5+ Water main/service line Surface water/drainage 110,o " loa(UW ) 72-026 (Rev. 7/91)Front -*PEi2 Z110187 UJSP&77W /Z P0&vLT CONTINUED ON BACK PAGE FT STATION Date instal e Size in gallons Vent (Y/N) High water alarm level "Pump on" I Manufacturer Manhole/Access (Y/N) Meets MOA electrical c (Y/N) SEPA ON DISTANCE FROM LIFT STATION TO: I on lot D. ABSORPTION FIELD DATA On adjacent lots p off level at tested Surface water Date installed Z�/o / F% Soil rating Z C r System type T76� C/I i Length A0 Width 2 Gravel thickness -Total depth Total absorption area 12 C) 4 Cleanouts presentt�Y N) !65 -- Depression —Depression over field (Y/6I /U0 Date of adequacy test 2 z3 1`Z Results pas /fail) LQ for4 r,&ooM5 bedrooms Peroxide treatment (past 12 months) (Y/N) Noti/E YNOCJN If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot No NE T On adjacent lots ZOU/t Property line /0 To building foundation -01 To existing or abandoned system on lot On adjacent lots I U '4- Cutbank —Water main/service line /© i Surface water No.v6 i�ZES&Jl_ Driveway, parking/vehicle storage area �Sv Curtain drain A10 -J& KMOIJW PM rNr`°EcrroN 4rpomr **/'dY< Hs-dvhcr Su2v6Y E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA c 5 & 5 ENGINEERING 17034 Eagle River Lo©p Road No. 204 Signature Eagle Rivev, Alaska 9957Y' Engineer's Name Date �2`�� - `�Z p� HAA Fee $ / % ? Date of Payment r°1 ✓/ �� Receipt Number 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee. $ Date of Payment Receipt Number ispection. DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99515 Scott S & S Engineering WALTER J: HICKEL, GOVERNOR' December 29,. 1992 SUBJECT: Spring Forest Subdivision Class "A" Public Water System, PWSID 213564 Dear Scott: (907) 349-7755 I have completed a review of this office's files concerning the monitoring status of the above -referenced Class "A" Public Water System and found the following: 1. 'The last satisfactory Total Coliform Bacteria Sample results was submitted to this Department on December 10, 1992. This does meet the provisions of 18 AAC 80.200(a), of the State Drinking Water -R—egulations. 2. The last inorganic Chemical Contaminants Sample results were submitted to this Department on January 28, 1991. This does meet the provisions of 18 AAC 80.200(a), of the State Drinking Water Regulations. 3. The last Radioactive Contaminants Sample results were submitted to the Department on November 10, 1992. This does _r�eat the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. 4. The last Organic Chemical Contaminants/Volatile Organic Chemical were submitted to this Department on June 16, 1992. This dog5mme_et the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. Issuance of this letter does not imply that the above -referenced Class "A" Public Water System is in compliance with other provisions of the State Drinking Regulations. If you have any questions on the above information, please do not hesitate to contact this office at 349-7755. Sincerely, /� O`er ` Michael Lu Environmental Eng. Asst. II ) pared on recycled paper by G.D. MUNICIPALITY OF ANCHORAGE `�� • -� Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES "��' 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # 0(S-3Z.I-2,�- HAA# tA�M La� 1, GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) S r('tel jv2 F -Gr t -T- Location Location (address or directions) /_/—I 1 LU�_S± (b) Property owner Mailing Address (c) Lending Institution ti' )- Mailing Address (d) Real Estate Company and Agent Address Telephone�� Telephone: (home) Business Telephone -mac l� C' k. f (e) Mail the HAA to the following address: (or check here if hold for pick up.) List contact person and day phone number below: �2Z 2. TYPE OF RESIDENCE 4- Single -Family Number of bedrooms (GI 3. WATER SUPPLY Individual Well ❑ Community Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site Cd' Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional .and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ��Telephone Address Q - ,01 �'Vl l 6I'y Date __ �C ll/� / 3 �cGel 6. DHHS APPROVAL .Approved for bedrooms byX101 Date A&e Approved Disapproved Conditional Terms of Conditional Approval • The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections oranalyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 inn. ✓t..: ;�naa e`•., `�� i 'v6!)4 ans .no STU a. en ock-' r,� w gineer's Seal e.�s� •.�. ; %ry Ct"�U`� ..:+ice 6. DHHS APPROVAL .Approved for bedrooms byX101 Date A&e Approved Disapproved Conditional Terms of Conditional Approval • The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections oranalyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) a Health Authority Approval (HAA) kQ E7 A o` r #�9f�LIST - FEBRUARY 1984 343-4744 t/IRr�NU rAt sEav(ces DIVISION Legal Description: JUN 2 1 1939 I(S10 Z_0 7- �, l3LoGK 2 A. WELL DATA R�CEIVED Well Classification L_ /-) s'—) A If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Total Depth Cased Static Water Level Casing Height Above Ground Date Completed Electrical Wiring in Conduit (Y/N) Depth of Grouting SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) On Adjoining Lots On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date Water Sample Test Results Comments Ss AgwP)vvecl 13. SEPTIC/HOLDING TANK DATA Date Installed I Aq+ Size /2-5-0 No. of Compartments Standpipes (Y/N) V Air -tight Caps (Y/N) y Foundation Cleanout (Y/N) y Depression over Tank (Y/N) Date Last Pumped1/� jr!?% Pumping/Maintenance Contact on File (Y/N) N ; for N/A Holding Tank High -Water Alarm (Y/N) N/A Temporary Holding Tank Permit (Y/N) NIA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well '� SOD To Building Foundation To Property Line To Water Main/Service Line 0 >!d To Disposal Field To Stream, Pond, Lake or Major Drainage Course _ ti / A Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 2-68 Type of System Design �T_ R E A) Cf/ Date Installed 2 / ) 0 / '7 Length of Field 'G> Width of Field 2-1 Depth of Field I i Gravel Bed Thickness 7 Square Feet of Absortion Area 1 2-0 Statndpipes Present (Y/N) Depression over Field (Y/N) nj Date of Last Adequacy Test 3 Results of Last Adequacy Test 3 /471,1 E,,gr-769- SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well 2_00 To Property Line -:> 2 O To Building Foundation 2-0 To Existing or Abandoned System on Lot 1 d ; On Adjoining Lots i SO To Water Main/Service Line J C To Cutback (if present) N/ To Stream, Pond, Lake, or Major Drainage Course ti /A To Driveway, Parking Area, or Vehicle Storage Area S S O Comments D. LIFT STATION 1\1116 Dated Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) **Check Permitt/l Bedroom Ring Against HAA Request** "Pump Off' Level at Vent(Y/N) I certify that I q- i )e or conformed to all MOA andinspection. /hecked, 146 Signed' Company rs- Date l �zd� MOA No. e/& 2 - Receipt No. Date of Payment�� ` 7 Amount: $ Receipt No. _ Waiver Fee: $ Pumping Cycles during Adequacy Test. in effec4 on the date of this L y C! J lV S T y'/„� (Y •S ��/� o "k✓ Date of Payment 72-026 (Rev. 7/8B) Back Page 2 of 2 Engineer's Seal STEVE COWPER, GOVERNOR U U� DEPT. OF ENVIRONMEN'T'AL CONSERVATION � ANCHORAGE WESTERN DISTRICT OFFICE 563-6775 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 FOR: Corwin & Associates DATE: June 20, 1989 PWSID: 213564 To Whom It May Concern: According to the records on file in this office, the Spring Forest Water System is in compliance with the State of Alaska Drinking Water Regulations. Sincerely, f �il�iz.Cp+i �Lr�-•l.lt�! VERA E. CRAIG, Environmental Field Officer VEC: gd MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date Z ///& % 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) SIT eIM6 PCO r? TEs� sic 33 j ��t� ,123i.Y/ Location (address or directions) d // a�'>�.S % / P, F-- f (b) Property Owner 67 Oe- Telephone: Home Mailing Address (c) Lending Institution 14 t) yi (-= tE:Q-V I I y Telephone Mailing Address (d) Real Estate Company and Agent a t— Address 3 Telephone `J G a r � S 0 -- (e) Mail the HAA to the following address: or: Check herey if hold for pick up. List contact person and day phone number below. '�? 2. TYPE OF RESIDENCE Single -Family Number of Bedrooms _ 3. WATER SUPPLY Business Individual Well ❑ Commu2muust Public El Note: If community well sI have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsitex Public ❑ Community ❑ Holding Tank ❑ Note�fI community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 fRev 8/86) Froni 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION A As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. � zl Address — I Date I ' L N�r y Engineer's Seal 4y� DHHS APPROVAL Approved for 0`�' edrooms by /"" �'°""` ' Date Approved Ll__� — Disapproved Conditional Terms of Conditional Approval CAUTION 2.—/3-8 The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-02e (Rev 8/851 Rack 5`pCHEALTH UNICIPALITY OF ANCHORAGE (MOA) pF PN%csQ%4 AUTHORITY APPROVAL (HAA) tlP�S�Rv CHECKLIST -FEBRUARY 1984 uN�G\eP� 264-4720 Legal Description: 40-16,, 2 S pitlJu (� ` A. WELL DATA ,`~oPjtE�sTy SpZ-L33 % 1al�Ir123tl/ Well Classification _ LA-S If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Date Completed Yield Total Depth Cased to Depth of Grouting Static Water Level Pump Set At Casing Height Above Ground Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot On Adjoining Lots To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by ; Date Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed B y Size v250 No. of Compartments 7—kA?-1 y Standpipes (Y/N) y Air -tight Caps (Y/N) Y Foundation Cleanout (Y///N) V Depression over Tank (Y/N) N Date Last Pumped ! Z�f0/9 1S44GS Pumping/Maintenance Contract on File (Y/N) ; for/ c Holding Tank High -Water Alarm (Y/N) N% Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well 5.2aq-e� To Building Foundation To Property Line 7 2O To Water Main/Service Line `J / O Course /\I 0 Comments Page 1 of 2 72-026(11/84) To Disposal Field To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design y 2 N Cf-) Date Installed )X 2 Length of Field 86 Width of Field Depth of Field Gravel Bed Thickness Square Feet of Absorption Area �a,dC�7 Standpipes Present (Y/N) _ Depression over Field (Y/N) �% Date of Last Adequacy Test _ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well 2ej�-p To Property Line �✓ Z To Building Foundation o� � To Existing or Abandoned System on Lot ��; On Adjoining Lots > ' D To Water Main/Service Line > / D To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments _ D. LIFT STATION Date Installed _ Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for _ Electrical Codes (Y/N) Comments v Dimensions Manhole/Access (Y/N) "Pump Off" Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that I have checked, verifie or conformed to all MOA nd HAA guidelines in effect on the date of this inspection. Signed Date Company MOA No. Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) 66) ,E o 'r.:.' `Y Engineer's Seal ,.Q 49fil I_ VI - oa. ae.• Ue.o Y tY... N 2225 JU VE 25, 1971/a� 03 W i AVE C SUITE 203 CONSULTING ENGINEER T)O2o Z ANCHORAGE. ALASKA 99501 TELEPHONE: (907) 2793916 S E P T I C S Y S T E M A D E Q U A C Y T E S T LEGAL: LOT 6, BLOCK 2, SPRING FOREST LOCATION: 6011 WEST TREE OWNER: GORDON HITCHINGS RESIDENCE: SINGLE FAMILY, FOUR BEDROOMS WELL: CLASS A, COMMUNITY WATER SYSTEM SEPTIC SYSTEM: FROM MUNICIPAL RECORDS: TANK: GREER STEEL, TWO COMP. 1250 GAL. ABSORPTION SYSTEM: TRENCH ABSORPTION AREA: 532 SQ. FT. SOIL RATING: 150 INSTALLATION DATE: JANUARY 1984 DATE OF PUMPING: DECEMBER 10, 1986. ISAACS PUMPING DATE OF TEST: DECEMBER 9, 1986 TEST PROCEDURE: SYSTEM WAS INSPECTED AND MEASURED. TANK WAS FOUND WITH 3.75 FEET OF COVER AND 48 INCHES OF LIQUID. TANK WAS 11 FEET FROM THE HOUSE FOUNDATION. DISTANCE BETWEEN TANK AND TRENCH IS LESS THAN THREE FEET. TRENCH WAS FOUND WITH TWO MONITORING TUBES. BOTH WERE DRY AND 11 FEET DEEP. ONE M.T. WAS BROKEN OFF AT GROUND LEVEL, THE OTHER HAD A STICK UP OF 6 INCHES. CLEAN WATER WAS ADDED TO THE SYSTEM USING THE TWO MONITORING TUBES AND THE TANK AS ACCESSES IN SUCCESSION. IT BECAME EVIDENT THAT THE WATER WAS NOT FLOWING FREELY FROM ONE END OF THE TRENCH TO THE OTHER. 300 GALLONS WAS ADDED THROUGH ONE PIPE. WATER LEVEL IN THAT PIPE ROSE FOUR FEET WHILE NO WATER WAS OBSERVED AT THE OTHER END OF THE TRENCH. WHEN THE FILL LOCATION WAS SWITCHED TO THE OTHER END OF THE TRENCH WATER ROSE IN THAT TUBE, WITH NO CHANGE IN THE OPPOSITE END. A TOTAL OF 650 GALLONS WERE ADDED. THIS CAUSED A WATER LEVEL OF 49 INCHES IN ONE TUBE AND 37 INCHES IN THE OTHER. 17 HOURS LATER THE RESPECTIVE WATER LEVELS WERE 33 INCHES AND 9. TEST RESULT: BASED ON THE ABOVE RELATED OBSERVATIONS, THIS SYSTEM DOES NOT MEET THE CODE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE. The operational life of all septic systems depends on the local soil conditions, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this septic system. We can therefore not give any estimate of how long the system will continue to meet the operational requi- rements of the Municipality and State. BILL SHEFFIELD, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION Telephone: 19071 Address: ANCHORAGE/WESTERN DISTRICT OFFICE 437 "Ell STREET, SUITE 303 274-2533 ANCHORAGE, ALASKA 99501 DATE: 12-08-86 PWS I.D.# 213564 To Whom it May Concern: According to records on file in this office the SPRING FOREST Water Regulations Water System is in compliance with the State Drinking Sincerely, ames C. Allen, RS ,�e Regional Sanitarian Supervisor MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicants Name ZC_....l� __ Tel�e�:hone - Bssinns$_,�__ Applicants Address`__?DF>C�`��_��_�_.______.!_?-�__.._._._ (c) Applicant is (check one) Tending Institution� Oc bui.lder C ; Buyer Other CZZ ( explain);✓ _ t 2� r9 t�" �r� /ho (d) Lending Institution Address (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: 2. Type of Residence Single -Family Multi -Family Other (describe Number of Bedrooms 3. Water Supply. Individual ;,ell E-1 Community- Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposa:L �. Onsite Public Community Holding Tank Note: If community well system, must have written confirmation from Che State E Department of Environmental Conservation attesting, to the legality and status. [Page 1. of 21 S. Engineering Firm Providing Inspections,_ Tests, File Search, IJat:a a- Infonuatic n 6. As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that, based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on -"site crater supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect; on the date of this inspection. Name of Firm Tele hone r AddressNA Date (ENGINEER SEAL) DHEP Approval Approved for �f bedrooms ApprovedL�L Disapproved Terms of. Conditional Approval By CAUTION �T .; g�ooe eo040 oyaa �.I�4 r e, na A').. Coo •' .r� :';,: V® Uq Ud0eU 0iE40dD 000111 �tia Occ1'+� �, Leroy i C. Reicl, Jr. C� mde P�o. 2251'C Conditional THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL (DREP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY_ UPON THE ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER IN THE S'L'ATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE OR OMISSIONS IN THE PROFESSIONAL ENGINEER`S WORK. (DHEP SEAL) RR4/ej/Dl8 PROTECTION REPRESENT - REGISTERED HOMES AND REQUIRE - BEFORE A FOR ERRORS (Page 2 of 2) 7-19.84 A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 AUG 2 9 4. Legal Description: Tgr Well Classification 411A If A, B, or Cr D.E.C. Approve 5/N); ,zt Well Log Present (YIN) MA Date Completed &( Yield Total Depth N/,Q Cased to rk./k Depth of Grouting J04 Static Water Level _ A)(Ii Pump Set At w�A_ Casing F.eight Above Ground /V 4 Sanitary Seal on Casing (YIN) Electrical Wiring in Conduit (Y/N) Depression Around bbllhead Separation Distances from X11: To Septic/Holding Tank on Lot .> r On Adjoining Lots AJ/,4 To Nearest Edge of Absorption Field on Lot_,,_, On Adjoining Lots uE To Nearest Public Sewer Line Qh To Nearest Public Sewer Cleanout/Manhole X)IA _ To Nearest Seer Service Line on Lot ul Water Sample Collected By JWA- Hate N/A¢. Water Sample Test Results V.)14 Comments B. SEPTIC/HOLDING TANK DATA Date Installed I Size / ZSD No. of Compartments Standpipes &) Air -tight Caps Y ) Foundation Cleanout Y ) Depression over Tank (Y ) Date Last Pumped AJlVe() Pumping/Maintenance Contract on File (Y/N) /Nfor Holding Tank High -Water Alarm (Y) N Temporary Holding Tank Permit Separation Distances from Septic/Holding Tank: To Water -Supply Well -t2 f1 D "�"yw To Building Foundation To Property Line To Disposal Field ip To Water Main/Service Line +10' To Stream, Pond, Lake, or Major Drainage [Page 1 of 2] "v�? <- �-� 2-15-84 C(o Aat"e�"I C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata / SD Cr Type of System Design of Field Length d Date Installed g — , WDepth of Field Width of Field i Gravel Bed Thickness _ Square Feet of Absorption Area Standpipes Present (Y ) Depression over Field (Y Date of Last Adequacy Test Results of Last Adequacy T@st Separation Distance from Absorption Field,, To Water -Supply M ll _•� 0,.0 l to Property Line t /O To Existing To Building Foundation �,� d�" g or Abandoned System on Lot ; On Adjoining Lots fI r To Water Main/Service Line To Cutbank(if present)A Al/c4- To Stream/Pond/Lake/or Major Drainage Course 4 -— To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Dimensions !panhole/ `ss (Y/N) puVb Off 11 Level at —� Vent (YM)_ Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** tifthat I have checked, verified, or, conformed to all MOA HAA Guidelines in effect I cery on the date„of this, inspection. Signed Company KB1/d5/s [Page 2 of 21 Date ?-2 Y 4Y MOA No. STV- d 'X •°�p`� EALr- !OU° °f Ou uc°a��vo a f3 Ler C. Reid, Jr. c°e o. 2251-F2-15-84 = ac�, u .t.• ALASKA �<WIRO11 MTAL COnTROL SbUIUS, InC. engineering & Cnuironmental Studies September 4, 1984 Department of Health and Environmental Protection 825 L Street Anchorage, Alaska 99503 Re: Spring Forest Subdivision, Block 2, Lot 6 Health Authority Dear Keith Bandt: MUNIC:IPAUV OF ANCI-10PAGE. DFPL OF tIFALTH & ENVIf20NbANTAL PPC)TECTION Sip 1984 On August 20, 1984 we performed a Health Authority Authorization (HAA) on the subject property. During the HAA, we noticed that the distance from the septic tank to the house foundation was only 3 feet. The required distance is 5 feet. The MOA Inspection was performed by John Kennedy on January 26, 1984. On the inspection form it indicates that the foundation is "proposed". There is no indication on the form or diagram of the position of the foundation cleanout, or even whether or not there was one in at the time of the inspection. Therefore, we cannot tell if the foundation location was changed after the inspection. In view of the fact that there is no way of determining what has occurred, and that the house is now completed, we are requesting a waiver of the foundation to septic tank cleanout from 5 feet to 3 feet. Approved By: Sincerely, �j en Turner E vronmental Scientist i 1200 LUesl 33rd Avenue. Suite B • Anchoraqe. Alaska 99503 • (901) 561-5040 ALASKA ENVIRONM�.JAL CONTROL SERVICES, INC. 1200 West 33rd Avenue Suite B ANCHORAGE, ALASKA 99503 Rhone 276.1361 JOB -), 6.'B0 Jp'a %KE57— SHEET NO. OF , CALCULATED BY �-+ ur�� — DATE4}T'�" CHECKED BY DATE ecel a j '/=__ -- GAOM92M, EBS Irc, Omtpt M- 01111.